![]() The criteria for selection were inclusion of all patients who had a swollen optic disc secondary to papilledema, clinically evident ONHD, buried ONHD and had undergone an OCT evaluation. The OCT videos and images of 94 eyes of 66 patients who had presented to Medical Research Foundation, Chennai from September 2010 to May 2013 were assessed retrospectively. Recently, the direct visualization of ONHD has been shown using the SD-OCT. Peripapillary retinal nerve fiber layer (PPRNFL) thickness comparisons in patients with ONHD and optic disc edema, and normal controls have been performed with time domain (TD)-OCT and in spectral domain (SD-OCT). Optical coherence tomography has been used in the literature to detect mild papilledema. The purpose of this study was to determine the findings on spectral domain optical coherence tomography (SD-OCT) in documented cases of true papilledema (TP), documented cases of ONHD (pseudopapilledema with disc drusen ) and PWD. This category also includes anomalous discs classically described as small discs with no cup and anomalous branching of the blood vessels. We prefer to term these patients as pseudopapilledema without evident ONHD (pseudopapilledema without disc drusens ). ![]() But in the absence of a documented ONHD by the above-mentioned investigations, it is very difficult to steer the course of further treatment in these patients. Autofluorescence has also been described to diagnose ONHD. Ultrasound, fundus fluorescein angiography (FFA), and a computed tomography (CT) of the orbits have been used to diagnose the ONHD which is seen as a hyper-reflective echo on the ultrasound B scan and a hyper-dense lesion at the optic nerve head on the CT. In the above scenarios, a confirmatory test to document an ONHD can save the patient from undergoing unnecessary invasive investigations and prolonged unwarranted treatment. Similarly, children presenting with a history of headaches with elevated discs and no visual complaints present a difficult situation for the treating ophthalmologist. To diagnose and confirm pseudopapilledema in patients with buried optic nerve head drusen (ONHD) who are often misdiagnosed as idiopathic intracranial hypertension (IIH) often poses a diagnostic dilemma.
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